Pregnancy

Objective To co-design best practice principles (BPPs) for providing compassionate, holistic support to fathers and non-birthing parents exposed to perinatal trauma.DesignParticipatory action research methodology to generate qualitative data.Setting, ParticipantsFace-to-face workshops were conducted across the Greater Brisbane area and online workshops were held for national consultation from 23 April 2024 to 27 May 2025. Fathers and non-birthing parents with lived experience of perinatal trauma and a multidisciplinary team of health and community care professionals were included. Separate consumer (n = 11) and professional (n = 30) reference groups were established to authentically represent lived experience and professional perspectives on caring for birthing families. The co-designed BPPs were subsequently validated in National Workshops with consumers from diverse backgrounds (n = 74).ResultsThe co-design process generated 24 initial themes, which were iteratively consolidated by consensus into four BPPs: (1) compassionate and inclusive engagement; (2) policy and legislative reform; (3) education and learning opportunities; and (4) mental health screening and support for fathers and non-birthing parents. Accompanying practice and policy recommendations for each BPP were developed.ConclusionsFathers, non-birthing parents and healthcare and community care professionals co-designed a suite of BPPs to address gaps in perinatal healthcare following exposure to pregnancy and birth trauma. Fathers and non-birthing parents expressed a strong need to be formally recognised as stakeholders and recipients of perinatal healthcare services. The BPPs offer a co-designed framework for broader systemic reform and an actionable roadmap for equitable, trauma-informed and culturally responsive care for all parents, emphasising the need for further translational research and the national integration of inclusive perinatal healthcare services.

Alka Kothari, Dale Trevor, Glen Quinn, Jane Geltch, Joel Dulhunty, Helen Skouteris, Leonie K. Callaway

Introduction The Living Evidence for Australian Pregnancy and Postnatal Care (LEAPP) program was established in 2023 to update and transition the Australian Pregnancy Care Guidelines into living guidelines and to establish new, living Australian Postnatal Care Guidelines. The program is a collaboration of the Australian Living Evidence Collaboration (ALEC), the Australian College of Midwives, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and 23 other Australian health organisations. The guidelines are developed using methods designed to meet the National Health and Medical Research Council standards. Clinical questions are prioritised by clinician and lived experience input. For each prioritised question, evidence is reviewed using systematic methods (existing published reviews or conducted de novo), contextual factors such as feasibility and equity are considered and new or updated recommendations are drafted. A lived experience panel and multidisciplinary clinical panels review draft recommendations. Unanimous endorsement by all 25 partner organisations is required before publication. Surveillance searches are conducted for most topic areas every 6 months. New and updated content is progressively added to the published guidelines.RecommendationsAs of August 2026 (version 11), the Australian Pregnancy Care Guidelines include 277 recommendations on more than 80 topics; 229 are new or updated since 2023. The new Australian Postnatal Care Guidelines include 149 recommendations on more than 20 topics. The guidelines are published online at https://livingevidence.org.au/living-guidelines/leapp/.Changes in Management as a Result of the GuidelineNew or updated recommendations include continuity of care, assessment and support on vaping, increased testing for syphilis, reduced testing for proteinuria, guidance on progesterone and cervical cerclage to prevent preterm birth, bereavement support, assessment and support for psychological birth trauma, screening for family violence, side sleeping in later pregnancy and a recommendation against vitamin D.

Miranda S. Cumpston, Anneliese Arno, Shaira N. Baptista, Shannon Barnes, Zoe Bradfield, Samantha P. Chakraborty, Caroline S. E. Homer, Stefan C. Kane, Nisha Khot, Steve McDonald, Steven McGloughlin, Tanya Millard, Jeremy J. N. Oats, Loyal Pattuwage, Matthew Quigley, Abdulbasit Seid, Rachel Silk, Alecia Staines, Anneliese Synnot, Alison Teate, Heath White, Tari Turner,

Objectives Hypertensive disorders of pregnancy (HDP) are a leading reason for medically indicated preterm birth (PTB), yet their contribution to population-level PTB trends is poorly understood. We examined temporal trends in PTB overall and HDP-associated PTB in Victoria over an 11-year period spanning the COVID-19 pandemic, and distinguished changes in HDP prevalence from changes in preterm delivery among affected pregnancies.Study TypePopulation-based interrupted time-series study using seasonal autoregressive integrated moving average (SARIMA) models, with July 2018 (launch of a national preterm birth prevention program) pre-specified as a temporal reference point.SettingAll hospitals in Victoria, Australia.Participants779,325 singleton births at ≥ 20 weeks' gestation between 1 January 2012 and 31 March 2022.Main Outcome MeasuresMonthly rates (per 1000 singleton births) of overall PTB, HDP and HDP-associated PTB. Decomposition analyses separated changes in HDP prevalence from changes in preterm delivery among affected pregnancies.ResultsOverall PTB was lower after July 2018 (5.8%–5.6%), while HDP prevalence increased (6.4%–7.0%). HDP-associated PTB increased before mid-2018 (+0.75 per 1000 births per month; 95% confidence interval [CI], 0.50–1.00) but declined thereafter (−1.12 per 1000 births per month; 95% CI, −1.88 to −0.36). This reversal was driven predominantly by reduced iatrogenic PTB with HDP; spontaneous PTB with HDP showed no significant change. Despite rising HDP prevalence, decomposition analyses estimated 89 fewer HDP-associated PTB cases than expected under pre-2018 patterns, reflecting a decline in the proportion of HDP pregnancies delivered preterm. PTB without HDP showed no significant temporal change.ConclusionPTB among HDP-complicated pregnancies declined despite increasing HDP prevalence, consistent with a shift towards later gestational age at delivery rather than reduced disease incidence. These findings may reflect improvements in care and demonstrate that reductions in iatrogenic PTB are achievable even as major risk factors become more prevalent.

Melvin Marzan, Heng Jiang, Daniel Lorber Rolnik, Joanne M. Said, Lisa Hui

Autism diagnoses have increased over the past decade, prompting debate on potential causes. In September 2025, US President Donald Trump claimed that paracetamol is a ‘big factor’ in autism, citing a systematic review based solely on observational studies. The review's selective reporting, methodological flaws (including applying an environmental health rather than evidence-based medicine framework) and lack of causal evidence provided weak justifications for its conclusions and have fuelled public confusion about paracetamol safety in pregnancy. This article critically appraises the review and examines how scientific uncertainty can be manipulated and amplified within broader public health domains.

David J. Tunnicliffe, Miranda Cumpston, Debra Kennedy, Margie Danchin, Armando Teixeira-Pinto

In a population cohort of 44,216 adolescent girls, about 73.5% of those who became pregnant were known to child protection services. Exposure to higher levels of child protection response was associated with increased cumulative incidence and an earlier age of pregnancy.

Oliver Watkeys, Kimberlie Dean, Kristin R. Laurens, Stacy Tzoumakis, Vaughan J. Carr, Melissa J. Green

Telehealth offers an opportunity to address limited access to early medical abortion during COVID‐19 and beyond Access to early medical abortion (EMA), using mifepristone followed by misoprostol to end an early pregnancy, remains a challenge in Australia, especially for women from vulnerable groups and those living in rural and regional areas.1 Low numbers of general practitioner providers, lack of peer networks to support the establishment and ongoing provision of EMA services, and stigma are real barriers as is a broader lack of knowledge regarding medical abortion among health professionals.2,3 Many women are also unaware of the availability of EMA and the current gestational limit of 63 days.4 They also face difficulties navigating the health system to find an EMA provider, particularly when they encounter conscientious objections.4,5 Women can also face other barriers such as needing to travel to access services, take time off work or find childcare, and many need to source financial support to meet the costs.5 The current coronavirus disease 2019 (COVID‐19) pandemic has further highlighted existing barriers to accessing EMA services in Australia. During the pandemic, there has been an increase in the demand for abortion because of a rise in unplanned pregnancies and domestic violence.6 Financial insecurity and delays in accessing abortion services, due to travel restrictions or other pandemic‐related stressors, means that women are often presenting for an abortion at a later gestational age.6 In addition, flight restrictions may have curtailed the ability of clinicians to travel to rural areas to provide surgical abortion services. Delivering EMA through telehealth has been shown to be safe, effective and acceptable to women, both internationally and in Australia.7,8,9 Originally championed by Women on Web (www.womenonweb.org), telehealth delivery of EMA was used to provide abortions clandestinely in countries where they were illegal, such as in Ireland prior to decriminalisation.10 It has now, however, been implemented in many countries worldwide, irrespective of whether restrictive or non‐restrictive abortion laws exist, to provide abortion care to women and improve access to women geographically isolated from EMA services.9 Using telehealth to deliver EMA offers an opportunity to address many of the barriers to EMA provision in Australia. It removes the necessity for proximity between the provider and patient, an issue of particular importance for women living in rural and regional areas where there are fewer abortion providers.5,7 The need to travel to appointments far from home, especially when more than one appointment might be required, can result in women moving past the 9‐week gestational limit and preclude them from being able to undergo an EMA.5,7 Not only does the telehealth delivery of EMA reduce the need for patients to travel but it also increases the capacity of existing providers to deliver services to women from a larger geographical area.5,8 The availability of Medicare Benefits Schedule (MBS) telehealth item numbers, introduced as part of the government's response to the pandemic, has meant that, for the first time, telehealth EMA can be delivered through Medicare to eligible patients.11 With these item numbers in place, all EMA providers are able to use telehealth to deliver this service at a potentially reduced cost to women. Before COVID‐19, telehealth item numbers had very restrictive criteria and could only be billed if the patient lived in a very rural area (Modified Monash Model 6 or 7 location), had an existing clinical relationship with a GP telehealth provider (defined as three face‐to‐face consultations in the previous 12 months) and lived at least 15 km by road from the GP.12 These restrictions unfairly excluded many women in metropolitan or regional areas, particularly young women (who comprise the largest demographic using abortion services), as this demographic does not necessarily attend GPs on a regular basis. It is imperative therefore that MBS‐funded telehealth remains implementable by all GPs so that women are not disadvantaged, and that telehealth abortion can remain accessible via Medicare. Recent restrictions to the temporary MBS item numbers for telehealth GP consultations, which came into effect on 20 July 2020 — namely restricting eligibility to only those who have visited the GP or practice in the previous 12 months or those who have been referred by a specialist except for where there is a current lockdown in place13 — will greatly reduce women's access to EMA. Placing restrictions on the eligibility criteria for MBS‐subsidised telehealth services severely affects women's access to GPs who can provide EMA, and discriminates against women who have not recently engaged with a GP due to various forms of disadvantage, such as family violence and unemployment. Exemptions to the restrictions have already been identified for people who are homeless and for children aged less than 12 months. Therefore, a further exemption should also be issued so that registered prescribers of medical abortion are able to use MBS telehealth item numbers for the benefit of Australian women. In addition, other measures are required to optimise the ability of telehealth to improve access to EMA for all Australian women. Firstly, a national hotline or online platform, similar to the 1800 My Options service (www.1800myoptions.org.au) in Victoria, which directs women to local abortion service providers, is required to assist women to identify an appropriate provider. Secondly, as outlined in a consensus statement on EMA developed by a coalition of key stakeholders (ie, the National Health and Medical Research Council's Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care [SPHERE]) and clinician experts,14 changes are required to current Therapeutic Goods Administration (TGA) and Pharmaceutical Benefits Scheme (PBS) provisions restricting the prescription of MS‐2 Step (mifepristone and misoprostol) to up to 63 days’ gestation.15 These criteria are outdated and discordant with current evidence demonstrating that EMA up to 70 days’ gestation is comparable in safety and efficacy to 63 days’ gestation or less.16 Guidance from the United States, Canada and the United Kingdom all concur.17,18,19 Increasing gestational limits for prescribing EMA will not only align Australia with international guidance but will also provide a greater window of opportunity for women to access this service. However, this change requires an application to be made to the TGA, and if TGA approval of the extended indication is successful, a subsequent application to the Pharmaceutical Benefits Advisory Committee for subsidy of the extended indication would be required. This is a costly and time‐consuming exercise. Thirdly, modifications are required to EMA protocols, particularly during the COVID‐19 pandemic. Internationally, “no‐touch/no‐test” protocols have been devised and endorsed to minimise the risk of COVID‐19 transmission between patients and providers and circumvent delays created by closed health services (ie, sonography).19,20 In the Australian context, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists has already advised that a clinician may appropriately decide not to administer anti‐D IgG before 10 weeks for the medical management of abortion, particularly when an additional visit may increase exposure of women and staff.21 The SPHERE coalition has additionally recommended that, during the COVID‐19 pandemic, while ultrasound is highly desirable for all women having a telehealth EMA, in situations where obtaining an ultrasound is a significant barrier or poses a significant risk during the COVID‐19 pandemic, EMA may proceed without the necessity of ultrasound assessment.14 However, the consensus statement emphasises that women should be carefully screened for risk factors for ectopic pregnancy. This requires an assessment as to whether an accurate gestational age can be estimated from the woman's history; a discussion regarding the risks of foregoing a pre‐procedure ultrasound as part of the consent process and supported by written information; and a robust follow‐up pathway.14 If the gestation is unable to be accurately identified, or there are red flags for ectopic pregnancy, then an ultrasound assessment must be arranged.14 Finally, abortion has been decriminalised in every state and territory in Australia except South Australia,1 where mifepristone can only be supplied in a hospital setting. This precludes South Australian women from being able to access EMA through community‐based providers such as GPs or via telehealth. The relevant South Australian legislation therefore requires a change.

Danielle Mazza · Seema Deb · Asvini Subasinghe